136 Repetitive Transcranial Magnetic Stimulation as a Protective Measure Against Early-Onset Alzheimer’s Disease: A Case Report

Abstract

BACKGROUND: Alzheimer s disease (AD) is a progressive neurodegenerative disease leading to cognitive decline and eventually death. Degradation of cortical neuroplasti-city is thought to be a major catalyst of AD-related cognitive decline. Repetitive transcranial magnetic stimulation (rTMS), which uses pulsed magnetism to stimulate neurons, increases cortical plasticity and induces long-lasting neuroplastic changes. Patients have benefited from rTMS to treat AD, especially when done in conjunction with cognitive training exercises. This case report presents a 31-year-old male who tested positive for an autosomal dominant mutation implicated in early-onset AD. rTMS and cognitive training were employed to assist in the delay of early-onset AD manifestation in two cycles. METHODS: Prior to each treatment cycle, the patient completed questionnaires and interviews designed to test his cognitive functioning; his spouse was interviewed to provide a third-party assessment of his functioning. Following pre-treatment data collection, 30 daily rTMS/ cognitive training sessions were completed in the first cycle and 35 daily rTMS/cognitive training sessions were completed in the second cycle. The bilateral dorsolateral prefrontal cortices each received 1,000 pulses (10 Hz, 110% SMT). Tolerability and side effect data were collected after each treatment. Immediately following rTMS, the patient played cognitive training games at our Brain Fitness Center. All pre-treatment assessments were repeated after completion of the 30 sessions in the first cycle and the 35 sessions in the second cycle for comparison of pre- to post-treatment cognitive functionality. RESULTS: Pre-treatment testing indicated the patient was asymptomatic before each cycle. The patient completed 30 daily rTMS sessions in the first cycle and 35 daily rTMS sessions in the second cycle. Tolerability/side effect data showed he tolerated treatment well and experienced only minor pain. The patient also completed30cognitive training sessions in the first cycle and 35 cognitive training sessions in the second cycle and showed moderate improvement across all cognitive domains. Post-treatment assessments indicated no change in functioning except to note the patient s improved sleep. A third treatment cycle is scheduled to begin in February 2020. S: This case report supports rTMS paired with cognitive training to be a safe and tolerable treatment for early-onset AD. However, more treatment cycles must be completed before conclusions about its efficacy can be determined.